Actual problems of neonatal cholestasis

Abstract

Jaundice, caused by a primary violation of the excretion of conjugated bilirubin, occupy a separate place in the structure of jaundice of the newborn. Obstructive jaundice is accompanied by the development of mechanical obstruction of the bile-ducts, which is clinically manifested by yellowish pigmentation of the skin and sclera. Neonatal hepatitis is the main cause of neonatal jaundice with a predominance of direct hyperbilirubinemia. It is resulted in atresia of the extra-hepatic or intrahepatic biliary tract. However, the hereditary nature of the disease cannot be ruled out. Neonatal jaundice workup is a very difficult task and requires non-routine laboratory and instrumental studies, such as abdominal ultrasound with duplex scanning and spectral Doppler ultrasonography, magnetic resonance imaging, liver elastography, percutaneous punctureliver biopsy. Consultation of a geneticist, hepatologist and surgeon is required. The treatment strategy of such severe neonatal pathology need complex, multidisciplinary approach and should be carried out only in highly specialized medical centers. The authors have analyzed the 3 clinical cases of neonatal cholestasis of various nature.